R E S E A R C H
Open Access
Modifiable factors which predict children
’
s
gross motor competence: a prospective
cohort study
Lisa M. Barnett
1,2*, Jill A. Hnatiuk
1,3, Jo Salmon
1,3and Kylie D. Hesketh
1,3Abstract
Background:Fundamental motor skills (FMS) are important for physical activity and healthy weight status in children, yet it is unclear which early childhood factors facilitate subsequent motor skill. The aim of this prospective study was to investigate which modifiable family and home environment factors in the early years predict children’s FMS at age five.
Methods:Mothers from the Melbourne InFANT program (registered with the International Standard Randomised Controlled Trial Number Register (ISRCTN81847050)) completed questionnaires when child was aged 4, 9, 19 months old, and 3.5 years old on factors hypothesised to predict motor skills. Some factors were grouped in tertiles (high, medium, low) due to the nature of the distribution. At 5 years old children were assessed on 6 locomotor and 6 object control skills (Test of Gross Motor Development-2). Eight regression models examined the association between factors at each time-point and children’s skills (object control and locomotor) at 5 years old.
Results:The sample varied by time-point (178 to 259 children). Maternal physical activity optimism (4 months;β= 2.43), home physical activity equipment (9 months;β= 0.82), time outdoors–middle (9 months;β= 2.50) and highest tertile (9 months;β= 2.86), time free to move about - highest tertile (19 months;β= 2.41), time with older children - middle (19 months;β= 3.15) and highest tertile (3.5 years;β= 3.00) were predictive of better locomotor scores. Mothers’own physical activity (9 months;β=−0.01) and time active with mum–highest tertile (3.5 years;
β=−3.73) were negatively associated with locomotor skill. Time with older children - highest (4 months;β= 2.27) and middle tertile (19 months;β= 2.97), time free to move about–middle (19 months;β= 2.55) and highest tertile (19 months;β= 2.47), and more home equipment (9 months;β= 0.83); (3.5 years;β= 0.17) were predictive of better object control skills. Maternal physical activity knowledge (3.5 years;β=−3.05) was negatively associated with object control skill.
Conclusions:Providing a supportive environment with older children and equipment, and allowing toddlers’ freedom to move, appears important. Opportunities exist to educate parents on their important role in developing children’s motor skills. Clinicians could advise parents that the home environment can make a difference to their child’s FMS starting from infancy.
Keywords:Early childhood, Physical activity, Object control, Locomotor, Home affordances
© The Author(s). 2019Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
* Correspondence:lisa.barnett@deakin.edu.au 1
Institute of Physical Activity and Nutrition, Deakin University, Geelong 3125, Australia
2School of Health and Social Development, Deakin University, Geelong 3125,
Australia
Background
Motor skill competence (e.g. fundamental motor skills such as balancing, jumping, and throwing) is integral to children being physically active, thus reducing chances of developing unhealthy physical activity and weight
trajec-tories [1,2]. Motor competence is developing during the
early years, the period up until 5 years old, and fundamen-tal motor skills become the precursors to more specialised movement and sport skills. Despite the importance of
fun-damental motor skills to children’s health and
develop-ment, research suggests children have poor motor competence. In Australia, only around half of children master skills such as throwing, kicking and jumping by
the end of primary school (around age 12 years) [3], and
this is reflective of data from other countries [4,5].
Systematic review and meta-analysis evidence suggests that it is possible to improve fundamental motor skills, and also physical activity, through preschool teacher-led
interventions [6]. Yet there is little understanding of
what social and environmental factors are important to foster in the home environment so young children have the best chance of developing adequate fundamental motor skills. A recent review noted the dearth of re-search regarding social and environmental factors that
might relate to children’s motor skills [7]. Furthermore,
systematic reviews of motor skill correlates have only in-vestigated potential correlates in children aged 3 and
above [7, 8]. This is important to understand because
children spend the majority of their time in the home
environment during early life [9]. Parents (and clinicians
who work with parents) have great potential to influence
children’s motor skill development by creating
environ-mental movement opportunities during the early years. Cross-sectional studies in infant children indicate the home environment is important, with availability of toys (both fine and gross motor) considered to enhance motor development associated with motor development
scores in Brazilian [10] and Japanese children [11].
Simi-larly, in another Brazilian study, home factors (physical space, daily activities, play materials) and global motor
score at 9 months old were positively associated [12]. In
18-month old African children, more developmental stimulation, measured in terms of variety in play mate-rials and activities where the child was engaged with an adult in the past 3 days, were associated with better
motor scores [13].
In preschool aged children there is some relevant cross sectional research on correlates of motor skill. For ex-ample, in 2011, in a large sample of Belgium children, some evidence was found for family level correlates of
motor skills [14]. In 2013, an Australian study reported
more evidence for correlates of motor skill at the child
level, than at the family and environmental levels [15].
More recently, in a disadvantaged sample from the United
States, a range of child, family and environmental factors were associated with motor skills showing that correlates
of fundamental motor skills are multidimensional [16].
There is a lack of longitudinal research focused on motor development pathways in children below school
age (i.e. younger than 6 years) [17]. The literature has
largely focused on motor milestones (rolling over, sitting up, crawling, and walking) as predictive factors for a
range of health outcomes [18, 19], rather than parent
modifiable practices and beliefs. One Brazilian cohort study assessed 49 infants three times over 4 months and found associations between home affordances, parental practices and knowledge, and infant motor development
over this time [20].
Identification of modifiable social and environmental be-haviours that could be undertaken by parents to enhance
their children’s subsequent motor skills, could be used to
inform movement-based guidelines for infants (until 12
months), toddlers (12–36 months) and pre-schoolers
(typic-ally aged 3–4 years) to assist parents, and clinicians who
ad-vise parents, such as early childhood nurses. Therefore, the purpose of this prospective study was to investigate which modifiable family and home environment factors in infancy,
toddlerhood and the early preschool years predict children’s
motor skills at age 5 years.
Methods
This analysis used data from the Melbourne Infant Feed-ing, Activity and Nutrition Trial (InFANT) Program; which was a 15-month obesity prevention intervention (2008 to 2010) targeted to first-time parents and their
infants between 4 and 19 months of age [21]. The
ori-ginal program aimed to educate and support first-time
parents in their approach to their infant’s dietary,
phys-ical activity and sedentary behaviours. Parents were guided in development of their parenting skills regarding developmentally appropriate eating and physical activity behaviours in their infant. Post-intervention follow-up
occurred when the child was aged 3·5 years (2011–2012)
and 5 years (2013). Parents were recruited through par-ent groups conducted from child health cpar-entres (idpar-enti- (identi-fied within randomly selected geographic government
areas). A total of 542 parent–child pairs (86% response)
from 62 different parent groups were involved in the ori-ginal intervention, with 480 (89% retention) families en-rolled at intervention end. The analyses in this paper does not report on intervention outcomes, but does ac-count for intervention status in all models (as a precau-tionary measure, despite no differences in motor skill observed between groups; data not shown).
months, 19 months and 3·5 years old. Children com-pleted the motor skill assessments at 5 years only. Chil-dren were included in analyses if they had motor skill data and also data from the relevant time-point. Ethical approval to conduct the study has been granted by the University Ethics Committee and by the Victorian Office for Children. Parents gave written informed consent for themselves and their children.
Demographic information were collected at baseline via a written questionnaire from the responding parent (all mothers), including maternal country of birth (Australia/Other), highest level of maternal education (Low = Secondary school or less; Medium = Trade cer-tificate/diploma; High = University qualification), mater-nal and child date of birth (to calculate age) and child sex. Age the child began crawling and walking were attained from maternal report questionnaires when child was aged 19 months.
The questionnaire described above also asked parents about a range of child and family factors investigated as potential correlates of motor skills. These included child behaviours (e.g., time spent on tummy), maternal beliefs (e.g., maternal self-efficacy), parental behaviours (e.g., maternal physical activity levels) and the home environ-ment (e.g., number of equipenviron-ment items available)
rele-vant at each time-point. Table 1describes the predictor
variables at each time-point.
The processing of many of these variables is consistent
with previous research with this sample [22]. However,
in this sample some items were grouped in tertiles (high, medium, low) rather than treated as continuous scores due to the nature of the distribution. Tertiles were cre-ated by allowing the statistical program to categorise the data based on its quantiles. For example, tertiles for some of the T4 variables were capped according to what would be considered a reasonable value for that factor, and cases were excluded if they exceeded these values.
For instance, ‘time spent with other children/older
chil-dren’ and ‘time spent free to move about’ were capped
at 14 h per day as this has been reported as the mean
waking time for child of this age [23]. ‘Time outdoors’
and ‘time spent being physically active with mum’ were
capped at 7 h/day as this was considered to be half a waking day. In this way it was possible to assess child behaviours relative to other children in the sample.
Due to differences in child development, not all mea-sures were relevant at each time-point, and hence were not assessed (for example, tummy time is no longer rele-vant once children begin crawling and walking and hence was not assessed beyond the 9 month time-point). Additionally, for some measures (maternal physical ac-tivity knowledge, parental facilitation of physical acac-tivity, and home equipment) the questions that comprised the measures differed between time-points. Two items
included in the maternal physical activity knowledge scale at T1 (time 1), T2 (time 2) and T3 (time 3) were dropped at T4 (time 4) as they were no longer relevant
due to the child’s age. Conversely, additional items (n= 4
at T3,n= 5 at T4) were added to the construct‘parental
facilitation of physical activity’ at T3 and T4 to more
comprehensively assess this construct as children grew up. Finally, whilst the home environment score at T1-T3
was drawn from maternal reports of how ‘likely’ they
were to provide equipment within the home over the
coming year [22], at T4, the measure assessed how
fre-quently the child used the piece of age-appropriate equipment at home. All constructs have shown adequate test-retest reliability in separate samples of infants,
tod-dlers and preschool children [15,22].
Children’s motor skill competence was assessed using
the Test of Gross Motor Development- 2nd Edition (TGMD-2); considered a valid and reliable instrument
[24]. It assesses 12 skills; six locomotor (run, gallop, hop,
leap, horizontal jump, and slide) and six object control skills (striking a stationary ball, stationary dribble, kick, catch, overhand throw, and underhand roll), according
to established protocols [24]. Motor skill data has been
published previously for a subsample of the current
sam-ple who also had accelerometry data [25]. In brief, each
skill was performed twice and video recorded in the home setting. If the home did not have the space in the backyard or front yard for the assessment, the garage space was sought or the front nature strip and in some cases local parks. Videos were coded by two experienced raters who had acceptable reliability on another study
[26]. Inter-rater reliability using Intra Class Correlations
(ICC) was assessed on a random subsample of 30 chil-dren at age 5 years for all 12 skills (ICC = 0.76, 95% CI
0.56, 0.88) [25] and for object control (ICC = 0.83, 95%
CI 0.67, 0.92) and locomotor (ICC = 0.70, 95% CI 0.45,
0.84) skills. Both attempts of a skill were scored (‘1’ if
component of the skill was correctly executed or ‘0’ if
not) and summed. Relevant skills were summed for a total locomotor and total object control skill score.
Data were analysed using Stata v. 15.0. Proportions and means were derived as descriptive statistics and
pre-sented in Table1. Separate multivariate linear regression
models (eight in total) were used to examine the associ-ation between all available child and family related
fac-tors at each time-point and children’s locomotor and
object control skills. In children aged 3 and older, corre-lates of skill differ according to how skill is operationa-lised and measured, so correlates were investigated separately in relation to object control and locomotor
skills [7]. All models controlled for child age and sex
(known covariates of motor skill competence [7]), the
months also controlled for the age the child began
walk-ing, as it was associated with children’s physical activity
levels in earlier analyses with this sample group [22].
Results
Table 1presents descriptive data for each of the
predic-tors at each time-point either as means/standard devia-tions, proportions (% yes/no) or the tertile cut points.
Table 2describes the demographic characteristics of the
study sample (mothers and children). There are almost even numbers of boys and girls in the sample. Mothers were mainly born in Australia, have a mean age of 32 and more than half have a University education. Com-pared to those lost to follow-up at 5 years old, the current sample was comprised of mothers who were more likely to have a university education and less likely to have a secondary school as their highest educational
attainment (Chi2= 5.5 p< 0.05). Children in the present
sample were also slightly younger (Mean [SD] = 3.61 [0.99] vs. 4.12 [1.81] months at baseline).
Table 3 reports associations between child and family
factors in early life and children’s locomotor skill at 5
years old. At 4 months, maternal optimism was posi-tively associated with locomotor skill score. At 9 months, physical activity equipment in the home was positively associated and maternal physical activity negatively
asso-ciated with children’s locomotor skill score. Further,
children in the middle and highest tertile for time out-doors had better locomotor skill score compared to those in the lowest tertile. Children who spent the most time (highest tertile) free to move about at 19 months and those children in the middle and highest tertile for time spent with older children at 3·5 years, had better
locomotor skill score compared to the lowest tertile groups at each time-point. Lastly, children who spent the most time being physically active with mum at 3.5 years had lower locomotor skill scores.
Table 4 reports the associations between child and
family factors at 4, 9, 19 months and 3.5 years and
chil-dren’s object control skill at 5 years. At 4 months, those
in the highest tertile for time spent with older children had higher object control skill score compared to those in the lowest tertile. At 19 months, those in the middle and highest tertiles for time spent free to move about and those in the middle tertile for time spent with older children, had better object control skills compared to those in the lowest tertile. At both 9 months and 3.5 years, children with more equipment in the home had higher object control skills. Maternal physical activity knowledge at 3.5 years was negatively associated with
children’s object control skill.
Discussion
The purpose of this study was to investigate a range of potentially modifiable infant, toddler and early preschool child, family and home environment factors
hypothe-sised to predict children’s motor competence at age 5
years. This is the first such study to investigate early life correlates of motor competence longitudinally from in-fancy through to 5 years.
Generally, the study showed that the home
environ-ment had some positive effects on their child’s
subse-quent motor skill development. Some of the stronger associations showed that an additional three points in skill could be achieved through certain environmental elements. This can be interpreted as three additional skill components correct in one trial of a skill (skills have between 3 and 5 components to be mastered). While we might expect stronger associations for the more prox-imal time-points, or that certain earlier experiences might be more important for subsequent motor skill de-velopment, overall, there were not clear patterns in the associations. Instead, there were a variable number of factors associated with both skill types at the different age points.
The most consistent association observed was for the number of age-appropriate toys and equipment available in the home environment. This was important at 9 months of age for locomotor and object control skills where there was an average of 6 home based toys suit-able for physical activity. At 3.5 years this item changed to assess how frequently children used the age-appropriate physical activity equipment items on a scale of never to daily. Engaging in toy use daily (on average) in 3.5 year olds was also associated with object control skills at 5 years old. It is logical that available toys and equipment could help to stimulate both locomotor and
Table 2Demographic characteristics of Melbourne InFANT
Program sample
Child characteristic
Age in months [mean (SD)] 3.6 (0.99)
Sex (% male) 51.6%
Age in months child began crawling [mean (SD)]a 8.2 (1.7)
Age in months child began walking [mean (SD)]a 13.0 (1.70)
Maternal characteristic
Age in years 32.4 (4.10)
Education
Low (Secondary school or less) 17.6%
Medium (Trade certificate or diploma) 22.6%
High (University bachelor’s degree or higher) 59.8%
Country of birth
Australia 83.2%
Other 16.8%
a
Table 3Child and family behaviours at child aged 4 months, 9 months, 19 months, 3.5 years and associations with locomotor skill at 5 years olda
Predictors of locomotor skill (potential range 0–48) at each age
Child and family behaviours Child at 4 months
(n= 256) β(95% CI)
Child at 9 months (n= 259) β(95% CI)
Child at 19 months (n= 195)b β(95% CI)
Child at 3.5 years (n= 178) β(95% CI) Child behaviours
Time spent being physically active with mum
Lowest tertile Ref. Ref. Ref. Ref.
Middle tertile −0.89 (−3.06, 1.27) 0.26 (−1.96, 2.47) −2.27 (−4.72, 0.16) −1.12 (−3.52, 1.30)
Highest tertile −1.68 (−4.46, 1.10) −1.66 (−4.19, 0.87) −1.36 (−4.28, 1.57) −3.73 (−6.68,−0.78)
Time spent having tummy time
Lowest tertile Ref. N/A N/A N/A
Middle tertile 0.19 (−1.93 (2.31) – – –
Highest tertile 1.75 (−0.61, 4.12) – – –
Time spent on the floor/free to move aboutc
Lowest tertile Ref. Ref. Ref. Ref.
Middle tertile 0.37 (−1.92, 2.65) −0.13 (−2.37 (2.10) 1.07 (−1.30, 3.44) 1.98 (−0.64, 4.60)
Highest tertile −0.60 (−3.17, 1.96) 0.29 (−2.15, 2.73) 2.41 (0.02, 4.80) −1.30 (−3.84, 1.22)
Time spent with other children of a similar age
Lowest tertile Ref. Ref. Ref. Ref.
Middle tertile 0.63 (−1.47, 2.74) −1.52 (−3.62, 0.56) 0.38 (−2.20, 2.97) −1.16 (−3.71, 1.38)
Highest tertile 0.90 (−1.33, 3.14) −1.53 (−3.98, 0.91) −0.43 (−2.90, 2.03) 0.04 (−2.74, 2.83)
Time spent with older children
Lowest tertile Ref. Ref. Ref. Ref.
Middle tertile 1.37 (−0.64, 3.38) −0.00 (−2.18, 2.18) 1.31 (−1.57, 4.21) 3.15 (0.72, 5.59)
Highest tertile 0.35 (−1.82, 2.53) −0.41 (−2.66, 1.84) 0.21 (−2.23, 2.66) 3.00 (0.09, 5.91)
Time spent outside
Lowest tertile Ref. Ref. Ref. Ref.
Middle tertile 0.30 (−1.90, 2.50) 2.50 (0.39, 4.62) 0.59 (−1.89, 3.07) 1.82 (−0.90, 4.54)
Highest tertile 0.68 (−1.51, 2.88) 2.86 (0.47, 5.26) 1.44 (−1.26, 4.13) 1.65 (−1.21, 4.51)
Organised activity (Ref. No) N/A N/A Ref. Ref.
Yes – – −1.19 (−3.23, 0.84) −1.67 (−0.94, 4.29)
Maternal beliefs
Maternal physical activity knowledge −2.37 (−5.15, 0.41) N/A −1.54 (−4.73, 1.65) −2.21 (−5.57, 1.15)
Maternal physical activity views 1.54 (−0.80, 3.88) N/A 0.88 (−1.83, 3.59) 0.61 (−2.06, 3.28)
Maternal physical activity optimism 2.43 (0.12, 4.75) −0.62 (−2.94, 1.70) −0.40 (−2.80, 2.01) 1.00 (−1.48, 3.47)
Maternal physical activity self-efficacy −1.03 (−3.24, 1.18) 0.42 (−1.69, 2.54) 2.16 (−0.32, 4.65) 1.61 (−0.88, 4.09)
Maternal floor concerns −0.31 (−2.04, 1.43) N/A N/A N/A
Parental behaviours
Parental facilitation of physical activity (mins/week) 0.06 (−0.11, 0.24) 0.02 (−0.15, 0.19) −0.02 (−0.12, 0.07) 0.01 (−0.11, 0.11)
Maternal physical activity (mins/week) −0.00 (−0.00, 0.00) −0.01 (−0.01,−0.00) −0.00 (−0.00, 0.00) −0.00 (−0.00, 0.01)
Home environment
Physical activity equipment in home 0.15 (−0.27, 0.57) 0.82 (0.05, 1.59) 0.29 (−0.23, 0.81) 0.06 (−0.07, 0.19) a
All models controlled for intervention group, sex and age of child and clustering by parents group attended. N/A = not assessed at particular time point b
Also controlled for age child began walking c
At 19 months and 3.5 years old, this variable was termed‘free to move about’rather than‘on the floor’
Table 4Child and family behaviours at child aged 4 months, 9 months, 19 months, 3.5 years and associations with object control skill at 5 years olda
Predictors of object control skill (potential range 0–48) at each age
Child and family behaviours Child at 4 months
(n= 256) β(95% CI)
Child at 9 months (n= 259) β(95% CI)
Child at 19 months (n= 195)b β(95% CI)
Child at 3.5 years (n= 178) β(95% CI) Child behaviours
Time spent being physically active with mum
Lowest tertile Ref. Ref. Ref. Ref.
Middle tertile 0.15 (−1.89, 2.20) 0.44 (−1.49, 2.37) −0.50 (−2.78, 1.76) 0.83 (−2.89, 1.23)
Highest tertile −1.94 (−4.56, 0.69) −1.44 (−3.64, 0.77) −1.49 (−4.22, 1.23) −1.30 (−3.89, 1.13)
Time spent having tummy time
Lowest tertile Ref. N/A N/A N/A
Middle tertile 0.81 (−1.20, 2.81) – – –
Highest tertile 1.71 (−0.52, 3.94) – – –
Time spent on the floorc
Lowest tertile Ref. Ref. Ref. Ref.
Middle tertile −0.48 (−2.64, 1.68) 0.25 (−1.71, 2.19) 2.55 (0.34, 4.76) −0.91 (−3.12, 1.31)
Highest tertile 0.98 (−1.45, 3.41) 0.02 (−2.10, 2.14) 2.47 (0.25, 4.70) −2.14 (−4.29, 0.01)
Time spent with other children of a similar age
Lowest tertile Ref. Ref. Ref. Ref.
Middle tertile 0.06 (−1.93, 2.06) −0.70 (−2.53, 1.12) −0.87 (−3.27, 1.53) 1.60 (−0.57, 3.77)
Highest tertile 0.69 (−1.43, 2.80) −0.54 (−2.68, 1.60) 0.11 (−2.18, 2.41) 1.31 (−1.07, 3.67)
Time spent with older children
Lowest tertile Ref. Ref. Ref. Ref.
Middle tertile 1.35 (−0.55, 3.26) 0.32 (−1.58, 2.22) 2.97 (0.28, 5.66) 0.07 (−1.99, 2.13)
Highest tertile 2.27 (0.21, 4.33) 1.45 (−0.51, 3.41) 0.73 (−1.55, 3.01) −0.28 (−2.74, 2.19)
Time spent outside
Lowest tertile Ref. Ref. Ref. Ref.
Middle tertile −0.54 (−2.62, 1.54) 1.03 (−0.82, 2.88) 0.12 (−2.20, 2.42) −0.30 (−2.60, 1.99)
Highest tertile −0.90 (−2.98, 1.8) 1.30 (−0.79, 3.40) 0.33 (−2.18, 2.84) 2.26 (−0.17, 4.70)
Organised activity (Ref. No) N/A N/A Ref. Ref.
Yes – – −0.51 (−2.41, 1.38) 1.11 (−1.07, 3.29)
Maternal beliefs
Maternal physical activity knowledge −0.68 (−3.31, 1.94) N/A −0.83 (−3.80, 2.13) −3.05 (−5.91,−0.19)
Maternal physical activity views −0.69 (−2.90, 1.52) N/A 0.41 (−2.11, 2.93) −0.15 (−2.43, 2.12)
Maternal physical activity optimism −0.88 (−3.07, 1.30) −0.51 (−2.54, 1.51) −0.86 (−3.09, 1.39) 0.23 (−1.89, 2.34)
Maternal physical activity self-efficacy −0.39 (−2.48, 1.70) −0.44 (−2.28, 1.41) 0.73 (−1.59, 3.05) 0.73 (−1.38, 2.84)
Maternal floor concerns 0.19 (−1.45, 1.83) N/A N/A N/A
Parental behaviours
Parental facilitation of physical activity (mins/week) 0.01 (−0.15, 0.18) −0.02 (−0.16, 0.13) −0.03 (−0.12, 0.06) −0.02 (−0.11, 0.08)
Maternal physical activity (mins/week) 0.00 (−0.00, 0.01) 0.00 (−0.00, 0.00) 0.00 (−0.00, 0.00) −0.00 (−0.00, 0.00)
Home environment
Physical activity equipment in home 0.26 (−0.13, 0.66) 0.83 (0.16, 1.51) 0.21 (−0.28, 0.70) 0.17 (0.06, 0.28)
a
All models controlled for intervention group, sex and age of child and clustering by parents group attended. N/A = not assessed at particular time point b
Also controlled for age child began walking c
At 19 months and 3.5 years old, this variable was termed‘free to move about’rather than‘on the floor’
object control skills, as this survey question could in-clude any sort of toy relevant to physical activity. This finding confirms a recent study in American preschool children which reported that physical activity equipment and/or play spaces present in the home was positively
related with locomotor skills [16] and replicates other
cross-sectional studies in infants [10, 11, 13] and
pre-school children [15]. In apparent contrast, one previous
study found that the frequency of buying equipment/
toys was not associated with preschool children’s motor
skills [14], although it is reasonable that the number of
toys/equipment and the frequency ofuseof such toys
re-late better to motor skill than the frequencywith which
they are bought.
At 19 months, children in the top tertile of time spent freely moving about (i.e. responses between 510 and 1440 min per week - approximately 73 min per day to 206 min per day), had significantly higher object and locomotor skills. Our finding supports the Australian 24-Hour Movement Guidelines for the Early Years, which state that toddlers (1 to 2 years) should be
en-couraged to “move regularly throughout the day, and
not be restrained for long periods” [27]. This
relation-ship wasn’t apparent at the 3.5 year old time-point which
could be because children were generally much less re-strained at this point. Interestingly, this relationship was not yet apparent in infancy, despite floor-based play be-ing identified in guidelines as important at such ages
[27]. It is possible that in this study children were not
engaged in the types of activities that are necessary to positively impact motor skills when placed on the floor as infants, as only total floor time was assessed. Alterna-tively, it is possible that the benefits of floor based play in infancy are not strong enough to be independently as-sociated with motor competence at 5 years of age.
Time spent outside at 9 months was predictive of loco-motor skill with children who spent between 34 and 69
min per week (mid tertile) and children who spent 77–
257 minnutes per week outside (high tertile) having better skills. Outdoor spaces and the novelty they may provide, might encourage locomotor development (crawling, scooting) in infants. It may also reflect that the child had more space to move around and that parental practices were less restrictive. It was surprising that outdoor time at preschool age did not relate to locomotor skills, given physical activity is correlated with motor skills and a
re-cent systematic review in 3–12 year olds found outdoor
time was consistently associated with more physical activ-ity and less sedentary behaviour compared to indoor time
[28]. An older cross-sectional Finnish study in children
aged 3–4 years, showed that parent-reported time playing
outdoors was associated with locomotor skill in terms of faster running, although, other skills (both object control and locomotor) were not associated with outdoor play
[29]. Therefore, whilst it appears that time outside benefits
physical activity, the potential for specific motor skill ben-efits may be less clear. Although, a recent representative study in Finnish preschool aged children showed time outdoors was related to both object control and
loco-motor skills [30]. A limitation of the current study is that
physical activity type was not assessed. Identifying what activities children engage in when they are outdoors (or indoors) at different ages may help determine optimal tivity types as well as duration of outdoor (or indoor) ac-tivity needed for development of which types of motor competence.
Time spent with older children was associated at 4 months (for children spending between 26 and 343 min
per week – high tertile) and 19 months of age (10–30
min per week – medium tertile), and at 3·5 years (50–
420 min per week–medium tertile), with object control
and locomotor skills respectively. From a motor develop-ment perspective this could be due to observation and imitation, i.e., a study in preschool aged siblings (5·4 and 3·5 years), found that older children usually initiated body-oriented tasks (e.g. crawl, walk, climb, jump) whilst the younger siblings watched, and that younger children often then imitated the tasks their older siblings had
completed [31]. In physical activity research, it has been
demonstrated in 3 to 6 year olds that being with another child facilitated more physical activity than when alone
[32] and in older children (6–11 years), having siblings
in the home was highly associated with physical activity
[33]. It is unclear why the highest tertile was not
associ-ated with either object control or locomotor skills at 19 months and 3.5 years, perhaps there is a ceiling effect in terms of the benefit a child can gain when playing with an older child.
Interestingly, maternal optimism about physical activ-ity when their baby was 4 months was important to sub-sequent locomotor skill (but not object control skill). It is also important to discuss the factors that were not as-sociated with either skill type. In terms of child factors, time spent having tummy time at 4 months was not as-sociated with either subsequent object control or loco-motor skills. This may be because our measure of loco-motor competence at age 5 years did not include a specific measure of stability. Previous research has demonstrated that motor object control and locomotor skills are
separ-ate constructs to stability [34]. Tummy time is
consid-ered important for infant development, particularly for reducing the severity of deformational plagiocephaly (skull deformity from repeated pressure due to head
be-ing in one position) [35]. Another child factor with no
association, was organised activity, which has been re-ported as a predictor of motor competence when
chil-dren are preschool aged [15]. We investigated it because
and baby gym, which might be expected to influence sub-sequent motor skills. The inconsistency in results in the current study may be due to sample characteristics (i.e. only one fifth of our sample did no organised activity) or the nature of the organised activities that children engaged in. For example, children may have been engaged in music
classes or other activities that don’t have a specific obvious
benefit to gross motor skill development.
In terms of family levels factors, with no associations or surprising associations, maternal self-reported phys-ical activity at child aged 9 months was negatively associ-ated with locomotor skill and thus was not in the hypothesised direction; however, this relationship was negligible. Time being active with mum for 3.5 year olds also had a negative relationship with locomotor skills. Potentially this could be due to how a parent defined as active time. If they were jogging/walking whilst child was restrained this would negatively affect skill develop-ment for instance. Parent facilitation of physical activity was not associated with either object control or loco-motor skill at any time point which is a surprising find-ing. Perhaps parents views of what they do regarding physical activity facilitation does not tie closely with motor development, for instance they might provide un-structured playtime which in intervention trials has been
shown to not improve children’s motor competence
when compared to structured interventions [36].
The study strengths include the longitudinal nature of the unique dataset with multiple time points across early childhood, the sample size, the reliable assessment of motor skills and the analytical methods adjusting for po-tential confounding variables and clustering. A challenge for analysis was that questions had to reflect the
chil-dren’s growth and development so they changed at each
time-point. It is important to note that behaviours are a best estimate by parents and thus can be treated as an indicator rather than being able to determine definitive times in certain behaviours and their relationship with motor skill. A high proportion of the sample had edu-cated parents thus affecting the generalisability of the re-sults. Future research may wish to consider gaining further information regarding other key significant others, in particular fathers, as fathers physical activity
has been associated with 4–6 year old children’s skills in
a prior study [14].
Conclusion
In conclusion, it is important to advise parents that the
home environment can make a difference to their child’s
motor competence and they can start right from infancy. Providing a home space with toys and equipment to fa-cilitate physical activity, maximising time for toddlers to be free to move about, providing opportunities for their toddler and preschool child to play with older children
(such as play group and kinder), and time outside, are all factors that will assist children to develop the skills they need to be physically active. These specific activities could also help inform physical activity guidelines for parents of young children. Whilst our findings support principles of the 24-Hour Movement Guidelines for the Early Years, they also emphasise the importance of the physical activity context to parents and caregivers, i.e. encouraging time for your child to play with others, be outside and have the equipment to facilitate physical ac-tivity and subsequent motor development. Thus, it is recommended that the context of physical activity be specified in future guidelines to help clinicians and
par-ents understand what they can do to enhance children’s
motor development.
What is also clear from this study is that there were large temporal variations in significant associations across the different time points and between the skill do-mains. Potentially the changing contexts over time and developmental milestones as they age may have contrib-uted to this mixed picture. Future research may seek to investigate these factors more closely so we can work to better understand how best to ensure children have the motor competence they need to be physically active.
Acknowledgements
Thank you to the parents and children who participated in this study.
Authors’contributions
LB conceived of the research question for this study, wrote the first draft of the background, methods and discussion, contributed to analysis methods and commented on the other sections. JH conducted the analysis, wrote the first draft of methods and results, and contributed to the drafts of the other sections. JS contributed to drafts and contributed to the design of the larger cohort study. KH managed and designed the data collection for the larger cohort study, and contributed to drafts. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.
Funding
The Melbourne InFANT Program and follow-ups were funded by National Health and Medical Research Council Project Grants (APP425801 & APP1008879). KDH is supported by an Australian Research Council Future Fel-lowship (FT130100637) and an Honorary Heart Foundation of Australia Future Leader Fellowship (100370). The funders played no role in the conduct of the study.
Availability of data and materials
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Ethics approval and consent to participate
Ethical approval to conduct the study has been granted by the University Ethics Committee (EC 175–2007) and by the Victorian Office for Children. Parents gave written informed consent for themselves and their children.
Consent for publication Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1Institute of Physical Activity and Nutrition, Deakin University, Geelong 3125,
Geelong 3125, Australia.3School of Exercise and Nutrition Sciences, Deakin University, Geelong 3125, Australia.
Received: 27 June 2019 Accepted: 20 November 2019
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